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Quality Analyst-Medicare Call Center

Job Summary:

Responsible for reviewing recordings of calls with Medicare members to determine if the call was handled in compliance with Medicare requirements and Plan customer service standards

Essential Functions:

• Provide subject matter expertise in Medicare call requirements
• Provide review, interpretation and implementation of state and federal guidance
• Score calls in accordance with quality scorecard
• Identify trends with call failures
• Mentor and provide feedback on calls
• Oversee and administer ongoing monitoring program(s) based on CMS guidance
• Updates policies, procedures and project work plans as needed.
• Adhere to established corporate policies and procedures
• Perform other duties, as necessary, to meet corporate objectives
• Travel as required

Qualifications:

• A minimum of five (5) years experience in a Medicare Advantage call center
• Must have strong Microsoft Office Suite skills. Advanced skills in Word, Excel, Access and PowerPoint: Required
• Experience with Medicare and/or Medicaid regulations and guidance: Required
• Advanced degree or certification in audit, pharmacy or compliance discipline: Preferred
• Prior project management training and/or experience: Preferred
• Must have strong verbal and written communication skills.
• Individual should be detail oriented with strong organization, prioritization and analytical skills with the ability to work independently.
• Must work well under tight timelines and adapt quickly to change in a fast-paced, team-oriented, and high-growth environment.

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